Kapisi, J;
Sserwanga, A;
Kitutu, FE;
Rutebemberwa, E;
Awor, P;
Weber, S;
Keller, T;
Kaawa-Mafigiri, D;
Ekusai-Sebatta, D;
Horgan, P;
et al.
Kapisi, J; Sserwanga, A; Kitutu, FE; Rutebemberwa, E; Awor, P; Weber, S; Keller, T; Kaawa-Mafigiri, D; Ekusai-Sebatta, D; Horgan, P; Dittrich, S; Moore, CE; Salami, O; Olliaro, P; Nkeramahame, J; Hopkins, H
(2023)
Impact of the Introduction of a Package of Diagnostic Tools, Diagnostic Algorithm, and Training and Communication on Outpatient Acute Fever Case Management at 3 Diverse Sites in Uganda: Results of a Randomized Controlled Trial.
Clin Infect Dis, 77 (Suppl 2).
S156-S170.
ISSN 1537-6591
https://doi.org/10.1093/cid/ciad341
SGUL Authors: Moore, Catrin Elisabeth
Abstract
BACKGROUND: Increasing trends of antimicrobial resistance are observed around the world, driven in part by excessive use of antimicrobials. Limited access to diagnostics, particularly in low- and middle-income countries, contributes to diagnostic uncertainty, which may promote unnecessary antibiotic use. We investigated whether introducing a package of diagnostic tools, clinical algorithm, and training-and-communication messages could safely reduce antibiotic prescribing compared with current standard-of-care for febrile patients presenting to outpatient clinics in Uganda. METHODS: This was an open-label, multicenter, 2-arm randomized controlled trial conducted at 3 public health facilities (Aduku, Nagongera, and Kihihi health center IVs) comparing the proportions of antibiotic prescriptions and clinical outcomes for febrile outpatients aged ≥1 year. The intervention arm included a package of point-of-care tests, a diagnostic and treatment algorithm, and training-and-communication messages. Standard-of-care was provided to patients in the control arm. RESULTS: A total of 2400 patients were enrolled, with 49.5% in the intervention arm. Overall, there was no significant difference in antibiotic prescriptions between the study arms (relative risk [RR]: 1.03; 95% CI: .96-1.11). In the intervention arm, patients with positive malaria test results (313/500 [62.6%] vs 170/473 [35.9%]) had a higher RR of being prescribed antibiotics (1.74; 1.52-2.00), while those with negative malaria results (348/688 [50.6%] vs 376/508 [74.0%]) had a lower RR (.68; .63-.75). There was no significant difference in clinical outcomes. CONCLUSIONS: This study found that a diagnostic intervention for management of febrile outpatients did not achieve the desired impact on antibiotic prescribing at 3 diverse and representative health facility sites in Uganda.
Item Type: |
Article
|
Additional Information: |
© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
Keywords: |
acute febrile illness, antimicrobial resistance, antimicrobial stewardship, behavior change, point-of-care tests, Humans, Case Management, Uganda, Outpatients, Malaria, Fever, Anti-Bacterial Agents, Ambulatory Care Facilities, Communication, Algorithms, Humans, Malaria, Fever, Anti-Bacterial Agents, Communication, Algorithms, Outpatients, Ambulatory Care Facilities, Case Management, Uganda, antimicrobial stewardship, antimicrobial resistance, acute febrile illness, point-of-care tests, behavior change, 06 Biological Sciences, 11 Medical and Health Sciences, Microbiology |
SGUL Research Institute / Research Centre: |
Academic Structure > Infection and Immunity Research Institute (INII) |
Journal or Publication Title: |
Clin Infect Dis |
ISSN: |
1537-6591 |
Language: |
eng |
Dates: |
Date | Event |
---|
15 July 2023 | Published | 25 July 2023 | Published Online | 25 May 2023 | Accepted |
|
Publisher License: |
Creative Commons: Attribution 4.0 |
PubMed ID: |
37490746 |
Web of Science ID: |
WOS:001043098000004 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/115649 |
Publisher's version: |
https://doi.org/10.1093/cid/ciad341 |
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